Provider Demographics
NPI:1598187627
Name:JP DENTAL GROUP P.C
Entity Type:Organization
Organization Name:JP DENTAL GROUP P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-210-2725
Mailing Address - Street 1:1032 PARK RD
Mailing Address - Street 2:
Mailing Address - City:BLANDON
Mailing Address - State:PA
Mailing Address - Zip Code:19510-9558
Mailing Address - Country:US
Mailing Address - Phone:610-926-9300
Mailing Address - Fax:
Practice Address - Street 1:1032 PARK RD
Practice Address - Street 2:
Practice Address - City:BLANDON
Practice Address - State:PA
Practice Address - Zip Code:19510-9558
Practice Address - Country:US
Practice Address - Phone:610-926-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty